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Impact of the COVID-19 Pandemic on Prenatal Care Utilization at a Public Hospital
Shae M Boguslawski1, Naima T Joseph2, Kaitlyn K Stanhope1
1Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
Prenatal care utilization remained similar during the COVID-19 pandemic, but pregnant individuals initiated care earlier and increased use of screenings and ultrasounds. Telehealth adoption was limited, though.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Digital Health
Background:
- The COVID-19 pandemic necessitated rapid adaptation of healthcare delivery models.
- Telehealth emerged as a potential solution to maintain essential services, including prenatal care.
- Understanding the impact of telehealth-supplemented models on prenatal care utilization is crucial.
Purpose of the Study:
- To compare prenatal care utilization rates before and after implementing a telehealth-supplemented model during the COVID-19 pandemic.
- To assess changes in antenatal screening, immunization, and emergency visit rates.
- To evaluate the impact on pregnancy complication rates.
Main Methods:
- Retrospective cohort study using electronic medical record data from Grady Memorial Hospital.
- Comparison of two cohorts: pre-pandemic (March-August 2019) and pandemic (March-August 2020).
- Statistical analysis using Pearson's Chi-square and two-tailed t-tests.
Main Results:
- Patients during the pandemic were more likely to start prenatal care in the first trimester and undergo gestational diabetes screening and ultrasounds.
- No significant difference was found in the mean number of prenatal care visits.
- Telehealth visit uptake was approximately 41%, while emergency department visits and labor induction rates increased during the pandemic.
Conclusions:
- Prenatal care utilization rates were comparable before and during the COVID-19 pandemic.
- Pregnant individuals receiving care during the pandemic initiated care earlier and utilized certain antenatal screenings more frequently.
- While telehealth adoption was moderate, the pandemic period saw increased use of specific screenings and higher rates of emergency visits and labor induction.
Objective:
The aim of the study is to compare rates of prenatal care utilization before and after implementation of a telehealth-supplemented prenatal care model due to the coronavirus disease 2019 (COVID-19) pandemic.
Study Design:
Using electronic medical record data, we identified two cohorts of pregnant persons that initiated prenatal care prior to and during the COVID-19 pandemic following the implementation of telehealth (from March 1, 2019 through August 31, 2019, and from March 1, 2020, through August 31, 2020, respectively) at Grady Memorial Hospital. We used Pearson's Chi-square and two-tailed t-tests to compare rates of prenatal care utilization, antenatal screening and immunizations, emergency department and obstetric triage visits, and pregnancy complications for the prepandemic versus pandemic-exposed cohorts.
Results:
We identified 1,758 pregnant patients; 965 entered prenatal care prior to the COVID-19 pandemic and 793 entered during the pandemic. Patients in the pandemic-exposed cohort were more likely to initiate prenatal care in the first trimester (46.1 vs. 39.0%, p = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, p <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, p = 0.006 and 56.9 vs. 47.3%, p <0.001, respectively) compared with patients in the prepandemic cohort. There was no difference in mean number of prenatal care visits between the two groups (6.9 vs. 7.1, p = 0.18). Approximately 41% of patients in the pandemic-exposed cohort had one or more telehealth visits. The proportion of patients with one or more emergency department visits was higher in the pandemic-exposed cohort than the prepandemic cohort (32.8 vs. 12.3%, p < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed cohort (47.1 vs. 38.2%, p <0.001).
Conclusion:
Rates of prenatal care utilization were similar before and during the COVID-19 pandemic. However, pregnant persons receiving prenatal care during the pandemic entered care earlier and had higher utilization of certain antenatal screening services than those receiving prenatal care prior to the pandemic.
Key Points:
· Patients initiated prenatal care earlier during the COVID-19 pandemic.. · Uptake of telehealth services was low.. · Rates of diabetes screening and ultrasound use increased during the pandemic..
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